Provider Demographics
NPI:1700981313
Name:KEVIN W, BURTON SR., D.D.S., P. A.
Entity Type:Organization
Organization Name:KEVIN W, BURTON SR., D.D.S., P. A.
Other - Org Name:BURTON FAMILY DENTAL & ASSOCIATES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:W
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:SR
Authorized Official - Credentials:DDS
Authorized Official - Phone:252-353-2111
Mailing Address - Street 1:1720 WEST ARLINGTON BLVD.
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-5998
Mailing Address - Country:US
Mailing Address - Phone:252-353-2111
Mailing Address - Fax:252-353-2115
Practice Address - Street 1:1720 WEST ARLINGTON BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-5998
Practice Address - Country:US
Practice Address - Phone:252-353-2111
Practice Address - Fax:252-353-2115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89015WFMedicaid